Case Studies

Health IT State of the Union

By Fred Sandsmark

February 2010

Deven McGraw is the director of the Health Privacy Project at the nonprofit Center for Democracy & Technology in Washington DC, where she helps develop and promote privacy and security protections for electronic health information. She has advised the Obama and George W. Bush administrations on ways information technology can improve healthcare.

Profit: What is the state of health IT in the U.S. today?

McGraw: Across the country, adoption of health IT is extremely low. There are three well-recognized barriers in the way: lack of funding, no real incentive to share information, and concerns about privacy. Some argue that the privacy issue is what stymied efforts to encourage health IT toward the latter end of the Bush administration—Congress couldn’t come to agreement on how to resolve the privacy questions.

Profit: What’s different now?

McGraw: The federal stimulus legislation [also known as the American Recovery and Reinvestment Act] has [US]$46 billion in incentives largely through Medicare and Medicaid to encourage adoption of health IT.

Profit: How does the stimulus address the barriers you mentioned?

McGraw: First, the ARRA has dollars dedicated to helping physicians, hospitals, and other providers purchase technology to keep electronic medical records. With respect to data sharing, providers can’t get incentive dollars unless they’re “meaningfully using” the technology, and part of the definition of meaningful use will be the sharing of data for coordination of care. The legislation is perhaps strongest on privacy. It changes the federal privacy rules under HIPAA to fill some gaps and make sure a privacy framework is in place as we create an e-health environment.

Profit: Where are we now in the health IT process?

McGraw: The critical task is to roll out health IT so that what we spend on technology gets the outcomes we want, which is not a computer on every desk, but improved care. The legislation is intended to get people thinking about health IT as a tool, not an end.

That’s why the meaningful-use provisions are in the statute. Providers don’t just get payments because they bought technology. They have to be meaningfully using it. Regulations [for meaningful use] currently being developed by CMS [the Centers for Medicare & Medicaid Services] are going to be critical.

Another trigger for getting incentives is to use “certified technology.” This is where standards become relevant. There’s enormous debate among policymakers and the federal advisory board I sit on over standards, and there’s a committee working on which standards [to use] to ensure interoperability of systems.

At the end of the day, I think most institutions and providers are going to want to take advantage [of stimulus dollars] because this kind of financial incentive will not come around again.

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